Clinical Symptoms, Imaging Features and Cyst Distribution in the Cerebrospinal Fluid Compartments in Patients with Extraparenchymal Neurocysticercosis

Abstract

Extraparenchymal neurocysticercosis has an aggressive course because cysts in the cerebrospinal fluid compartments induce acute inflammatory reactions. The relationships between symptoms, imaging findings, lesion type and location remain poorly understood. In this retrospective clinical records-based study, we describe the clinical symptoms, magnetic resonance imaging features, and cyst distribution in the CSF compartments of 36 patients with extraparenchymal neurocysticercosis. Patients were recruited between 1995 and 2010 and median follow up was 38 months. During all the follow up time we found that 75% (27/36) of the patients had symptoms related to raised intracranial pressure sometime, 72.2% (26/36) cysticercotic meningitis, 61.1% (22/36) seizures, and 50.0% (18/36) headaches unrelated to intracranial pressure. Regarding lesion types, 77.8% (28/36) of patients presented with grape-like cysts, 22.2% (8/36) giant cysts, and 61.1% (22/36) contrast-enhancing lesions. Hydrocephalus occurred in 72.2% (26/36) of patients during the follow-up period. All patients had cysts in the subarachnoid space and 41.7% (15/36) had at least one cyst in some ventricle. Cysts were predominantly located in the posterior fossa (31 patients) and supratentorial basal cisterns (19 patients). The fourth ventricle was the main compromised ventricle (10 patients). Spinal cysts were more frequent than previously reported (11.1%, 4/36). Our findings are useful for both diagnosis and treatment selection in patients with neurocysticercosis.

Natural History of Treated Subarachnoid Neurocysticercosis

“…The complications due to NCC in this series are similar to prior reports (Table 3). 10,12 Increasing frequency and severity of headaches commonly led patients to seek medical advice. Among the patients, 55.9% developed hydrocephalus (and associated symptoms) with 41.2% requiring a VP shunt and one person undergoing ventriculostomy of the 3 rd ventricle (patient 21).…”

“…Some investigators use a short 8-10-day course of high-dose albendazole and dexamethasone or 15 days of praziquantel 28 with cyst regression as a measure of effectiveness. 10,28,[30][31][32][33] However, this regimen is frequently unsuccessful, requiring one or more retreatments. 33,34 Furthermore, the duration of follow-up is often short and longer term outcomes, including morbidity, mortality, side effects of treatment, and recurrence rates of this treatment approach, are unclear.…”

“…3,4,[6][7][8] Because cystic vesicular structures degenerate to arachnoiditis (enhancement by MRI examination) directed to cyst walls with or without prior anthelminthic treatment or may not have been able to fully form, the presence of vesicular cystic structures are not required to define SUBNCC. Depending on the series and case definition, which many times include ventricular involvement, the prevalence of subarachnoid disease varies, [9][10][11] but in a large and well-defined series in the United States made up about 20% of unselected cases. 12 In its most advanced form, multiple brain cisterns are enlarged causing varying degrees of mass effects.…”

Subarachnoid racemose neurocysticercosis with cerebellar involvement: an old friend in an infrequent location?

“…NC is subdivided by its location into parenchymal or extra-parenchymal forms, the latter being the less frequent. Extra-parenchymal neurocysticercosis involves infection of the subarachnoid space, the spinal cord (except in the rare case of intramedullary NC) or the ventricular system 3 , 5 , 6 . The prevalence of subarachnoid NC is not known, and high variability exists in the few studies in the literature 7 .…”

Effect of Albendazole Treatment in an Experimental Model of Neurocysticercosis-Induced Hydrocephalus

“…5 The extraparenchymal form of NCC has a more aggressive course because cysts in the cerebrospinal fluid (CSF) compartments can elicit an intense inflammatory reaction, leading to vasculitis, hydrocephalus, and increased intracranial pressure. 6,7 Hydrocephalus is a major concern in extraparenchymal NCC, as patients with NCC-induced hydrocephalus have higher rates of morbidity and mortality. The management of NCC-related hydrocephalus is also more challenging than that of hydrocephalus of other etiologies because of the higher rates of shunt malfunction, infection, and the need for reoperation.…”